A patient expresses intent to harm themselves but refuses transport. What is an appropriate EMS action?

• A. Respect patient autonomy and leave
• B. Provide basic first aid and no transport
• C. Attempt verbal de-escalation and involuntary transport if necessary
• D. Call law enforcement to arrest the patient

Answer: (C)

Protecting life while respecting autonomy in a patient who is suicidal and refuses transport. When someone expresses intent to harm themselves, the priority is safety and a careful assessment of their capacity to refuse care. Start with verbal de-escalation: speak calmly, listen actively, acknowledge their distress, and reduce any immediate means of self-harm if possible. At the same time, assess their mental status and whether they can understand the risks and consequences of refusing transport. If they demonstrate clear capacity and still refuse, you should respect their autonomy, but document the assessment and arrange appropriate follow-up care. If there is imminent risk or they cannot appreciate the danger or make a rational decision, involuntary transport is appropriate to protect them. This may require a supervisor’s involvement and, when needed, assistance from law enforcement or a mental health crisis team to facilitate safe transport. Leaving the scene, providing care without transport, or using arrest as the primary method to obtain transport does not adequately address the risk to the patient.